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[Influence of body position on ocular cycloposition in patients without binocular vision].

PURPOSE: Positionally induced cyclotorsion could be an important factor concerning correction of astigmatism in refractive surgery. Previous studies have shown no influence of body position on cycloposition in healthy subjects with normal binocular vision. METHODS: 10 subjects (median value of age 44.2 years) without binocular vision due to an organic eye disease or to strabismus were examined using three-dimensional video-oculography (3D-VOG). This non-invasive method can record changes in the position of both eyes simultaneously in the x-, y- and z-axes. The cycloposition of the eyes was recorded first in a seated position with both eyes open (test 1), then in a supine position with the right eye closed (test 2), then in a supine position with occlusion of both eyes (test 3), and then in a supine position with both eyes open (test 4). In each of these 4 situations, the eyes were recorded for 1 minute. Cyclovergence was calculated as the difference between the right and the left eye positions. RESULTS: The range of cycloposition of the right and left eye in all 4 tests was very small. 95 % confidence intervals for cycloposition of the right and left eyes and for cyclovergence: cycloposition right eye/cycloposition left eye/cyclovergence: 0.72;0.76/- 0.07;0.01/0.71;0.79 (test 1), 0.23;0.29/0.19;0.33/- 0.81;- 0.63 (test 2), - 0.92;0.7/- 0.51;- 0.37/- 0.79;- 0.45 (test 3), 0.14;0.52/- 0.07;0.31/0.59;0.21 (test 4). There was no statistically significant difference of the cycloposition between the 4 test situations. CONCLUSIONS: The cycloposition of the eyes does not significantly change between seated and supine positions of the body, either in subjects with, or without binocular vision. This means for refractive surgery that a correction of astigmatism, to be performed in the supine position of the patient, can be based on a measurement of the axis of astigmatism obtained in the seated position.

Adult↗

Ventilatory sensitivity to mild asphyxia: prone versus supine sleep position.

AIMS: To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal. METHODS: Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. The asphyxial test mimicked face down rebreathing by slowly altering the inspired air: CO(2), maximum 5% and O(2), minimum 13.5%. The change in ventilation with inspired CO(2) was measured over 5-6 minutes of the test. The slope of a linear curve fit relating inspired CO(2) to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Sleep state and arousal were determined by behavioural criteria. RESULTS: At 3 months of age, prone positioning in AS lowered VAS (0.184 prone v 0.269 supine, p = 0.050). At newborn age, sleep position had no effect on VAS. Infants aged 3 months were twice as likely to arouse to the test than newborns (p = 0.013). Placing infants prone as opposed to supine increased the chances of arousal 1.57-fold (p = 0.035). CONCLUSION: Our findings show 3 month old babies sleeping prone compared to supine have poorer ventilatory responses to mild asphyxia, particularly in AS, but the increased prevalence of arousal is a protective factor.

Arousal↗

Effect of maternal posture on the umbilical artery flow velocity waveform.

The effect of maternal postural changes on the umbilical artery flow velocity waveform, fetal heart rate and maternal blood pressure was studied in 27 normal singleton pregnancies between 23 and 36 weeks of gestation. A statistically significant change in umbilical artery Pulsatility Index (PI) was established for both maternal standing to supine position (rise) and supine to standing position (drop). These PI changes were not related to gestational age. A statistically significant drop in maternal systolic blood pressure was observed from standing to supine position. The rise in umbilical PI resistance when changing from standing to supine position may be caused by the sluice flow mechanism.

Adolescent↗

Effect of body position on ventilatory responses in anaesthetised mice.

The effects of body position on ventilatory responses to chemical stimuli have rarely been studied in experimental animals, despite evidence that position may be a factor in respiratory results. The purpose of this study was to test whether body position could affect acute ventilatory responses to 4-min periods of moderate hypercapnia (5% CO(2) in O(2)) and poikilocapnic hypoxia (15% O(2) in N(2)) in the urethane-anaesthetised mouse. Respiratory measurements were conducted with mice in the prone and supine positions with a whole-body, single-chamber plethysmograph. During hypoxia, the time course of minute ventilation (V (E)) was similar in the two positions, but the breathing pattern was different. After the response peak, V (E) depended on respiratory frequency (f) and tidal volume (V(T)) in the prone position but mainly on V(T) in the supine position. In the supine position, f declined below the baseline values toward the end of hypoxic exposure. During hypercapnia, there were no ventilatory differences between the prone and supine positions. Brief hypoxic exposure elicited f depression in the supine position in the anaesthetised mouse. The depressive effect on f suggests that the supine position may not be optimal for sustaining ventilation, particularly during hypoxia.

Anesthesia↗

Kinetics of oxygen uptake during supine and upright heavy exercise.

It is presently unclear how the fast and slow components of pulmonary oxygen uptake (VO(2)) kinetics would be altered by body posture during heavy exercise [i.e., above the lactate threshold (LT)]. Nine subjects performed transitions from unloaded cycling to work rates representing moderate (below the estimated LT) and heavy exercise (VO(2) equal to 50% of the difference between LT and peak VO(2)) under conditions of upright and supine positions. During moderate exercise, the steady-state increase in VO(2) was similar in the two positions, but VO(2) kinetics were slower in the supine position. During heavy exercise, the rate of adjustment of VO(2) to the 6-min value was also slower in the supine position but was characterized by a significant reduction in the amplitude of the fast component of VO(2), without a significant slowing of the phase 2 time constant. However, the amplitude of the slow component was significantly increased, such that the end-exercise VO(2) was the same in the two positions. The changes in VO(2) kinetics for the supine vs. upright position were paralleled by a blunted response of heart rate at 2 min into exercise during supine compared with upright heavy exercise. Thus the supine position was associated with not only a greater amplitude of the slow component for VO(2) but also, concomitantly, with a reduced amplitude of the fast component; this latter effect may be due, at least in part, to an attenuated early rise in heart rate in the supine position.

Adult↗

[Prone position favors motor development of infants].

OBJECTIVE: To determine the motor development in infants sleeping in the supine position compared to infants sleeping in the prone position, and to compare the levels of motor development of infants playing only in the supine position and of infants playing in the prone position as well. DESIGN: Prospective blinded comparing study. SETTING: Department of Physical Therapy, Maasziekenhuis, Boxmeer, the Netherlands. METHODS: Various measuring instruments were used in the home environment to determine the levels of motor development at the age of 5 months of 21 healthy infants born at term selected from a group of 160 infants attending the infant welfare clinic. RESULTS: Infants sleeping in the prone position (n = 8) showed a higher motor development than infants sleeping in the supine position (n = 13). Infants playing in the prone and supine position (n = 5) had a higher motor development than infants who played exclusively in the supine position (n = 15). CONCLUSION: Sleeping and playing in the prone position was accompanied by a higher motor development in healthy mature-born infants at the age of 5 months.

Child Development↗

The effect of body position on bioelectrical resistance in individuals with spinal cord injury.

The purpose of this study was to determine the effect of four different body positions on the resistance of the human body as assessed by Biodynamics Model 310 Body Composition Analyzer in a healthy population (Group A, n = 69) and long-term spinal cord injured (Group B, n = 13). Group A were tested in four body positions: supine, half-lying, standing and sitting in a wheelchair, while Group B were tested in supine and sitting positions. Testing order was randomized. A one-way repeated measures analysis of variance and a paired t-test demonstrated significant differences between position (p < 0.0001, Group A; p < 0.01, Group B respectively). In both groups, the greatest reduction in resistance was demonstrated for the sitting position. These differences were similar for both groups, as demonstrated by covariant analysis. Regression analysis demonstrated that supine resistance can be accurately predicted (R2 = 0.98) from assessments in a wheelchair. Such data transformations may be indicated where supine positioning is problematic or when wheelchair assessment procedures are more appropriate.

Adult↗

Women's position during labour: influence on maternal and neonatal outcome.

AIM: To assess the maternal, perineal and neonatal outcomes of an upright position compared with a supine position during vaginal delivery, in terms of defined outcome variables. METHODS: This case-control study was carried out at the Department of Obstetrics and Gynaecology of the University Hospital Vienna between 1997 and 2002. A total of 307 women who delivered in an upright position were enrolled in the study. Upright position was defined as free squatting and was also described as an alternative birth position. 307 controls, delivering in a supine position, were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. Our analysis was restricted to a sample of women with a gestational age > 37 weeks, a normal sized fetus and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded. RESULTS: A statistically significant decrease for the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.001) was observed in women using the upright birth position. The length of the first and second stages of labour did not significantly differ between the two groups (p > 0.05). A significantly lower rate of episiotomy was detected in women who delivered in an upright position compared with women delivering supine (p = 0.0001). The frequency of perineal tears, and vaginal and labial trauma did not differ between the two groups (p > 0.05). When analysing maternal blood loss, no significant differences between the two groups were found (p > 0.05). No differences in APGAR score < 7 at 1 and 5 minutes or cord pH < 7.1 were observed (p > 0.05). CONCLUSIONS: The data indicate that labouring and delivering in an upright position is associated with beneficial effects such as a lower rate of episiotomy, and a reduced use of medical analgesia and oxytocin. In our opinion, the best recommendation is to give low-risk maternity patients the option of bearing in the mode that is most comfortable for them.

Adult↗

[Evaluation of effective jaw position and body posture for oral appliance of patients with obstructive sleep apnea syndrome].

PURPOSE: The aim of this study was to evaluate whether substantial airflow changes occur by changing both jaw position and body posture in normal subjects and patients with obstructive sleep apnea syndrome (OSAS). METHODS: Fifteen normal controls (9 males and 6 females) and 15 male OSAS patients participated in this study. For all subjects their maximum forced inspiratory flow (FIF(25-75)) curve was measured in seven positions as follows: a) 0% jaw forward-upright position, b) 0% jaw forward-supine position, c) 50% jaw forward-supine position, d) 75% jaw forward-supine position, e) 0% jaw forward-lateral position, f) 50% jaw forward-lateral position, and g) 75% jaw forward-lateral position. RESULTS: Although FIF(25-75) was increased by changing the body posture from supine to lateral in normal subjects, it was not increased by increasing the jaw forward position of them. On the other hand, the more forward the jaw position, the more FIF(25-75) increased in OSAS patients. However, it was not increased by changing the body posture of them. There were no significant differences between the 50% forward and 75% forward jaw positions in both groups. CONCLUSIONS: In normal subjects, change of jaw position was more effective than that of body posture for FIF(25-75). However, in OSAS patients, change of body posture was more effective than that of jaw position for FIF(25-75). It was suggested that the treatment effect in the 50% forward position was similar to that in the 75% forward position.

Adult↗

Influence of position during examination, and sex of examiner on patient anxiety during pelvic examination.

It has been reported that adult women prefer the semi-sitting position over the supine position for the pelvic examination. We determined the effect of the pelvic examination position and the examiner's gender on adolescent anxiety with the pelvic examination. Adolescent girls (n = 112) aged 12 to 19 years were randomly assigned to a semi-sitting or supine position and to a male or female physician. Before and after the examination questionnaires containing the Spielberger State-Trait Anxiety Inventory and other scales were administered. There were no differences between the groups in pre-examination anxiety or concern. Patients in the semi-sitting group reported fewer negative responses during the examination when examined by a male physician (P less than or equal to 0.009); those in the supine group reported fewer negative responses when examined by a female physician. These findings persisted after controlling for previous pelvic examinations, frequency of sexual activity, and Tanner stage. Patients who had previously had a pelvic examination and were examined in the semi-sitting position by a male physician reported the lowest levels of post-examination anxiety (P less than or equal to 0.02). Patients who had never had a pelvic examination expressed less anxiety if they were examined in the semi-sitting position by a female physician. These data suggest that the patient's previous history of pelvic examinations and the gender of the examiner should be considered when selecting the pelvic examination position.

Adolescent↗

Continuous ambulatory radionuclide monitoring of left ventricular function: effect of body position during ergometer exercise.

UNLABELLED: We assessed the reliability of a continuous ambulatory radionuclide monitoring system (the VEST system, Capintec, Inc., Ramsey, NJ) for measurement of left ventricular performance during exercise in the upright and supine positions. METHODS: Sixteen healthy male volunteers (aged 32-46 yr; mean age 37 +/- 4 yr) were studied. All volunteers underwent ergometer exercise testing in both the upright and supine positions, and left ventricular performance was determined with the VEST system. RESULTS: The resting heart rate, systolic blood pressure, pressure rate product, relative end-diastolic volume, relative end-systolic volume and left ventricular ejection fraction (LVEF) all showed no differences between the upright and supine positions. At peak exercise, the heart rate, systolic blood pressure and pressure rate product showed no differences between the upright and supine positions. In the upright position at peak exercise the relative end-diastolic volume was increased (83% +/- 9% to 91% +/- 11%, p < 0.001); the relative end-systolic volume remained unchanged (34% +/- 3% to 33% +/- 15%), and LVEF was significantly increased from 58% +/- 6% to 66% +/- 11% (p < 0.01). In the supine position at peak exercise, the relative end-diastolic volume remained unchanged (85% +/- 5 to 83% +/- 7%), the relative end-systolic volume was increased (35% +/- 5% to 43% +/- 13%, p < 0.01), and LVEF was decreased from 58% +/- 5% to 48% +/- 17% (p < 0.01). These results indicated inferior data collection by the VEST system in the supine position. CONCLUSION: Since the detector of the VEST system may be too small, the data collection is impaired during exercise in the supine position by shifting the heart with deep respiration. The VEST system is very useful for determining left ventricular performance when applied in the sitting or upright position. However, in the supine position during exercise, the use of the VEST system should be avoided because it might indicate an artifactual deterioration of left ventricular performance.

Adult↗

A new method for the assessment of tissue hemoglobin oxygenation in patients with chronic venous insufficiency.

Venous incompetence often leads to ulceration of the skin of the lower limb due to a disturbance of skin microcirculation. We investigated 10 healthy subjects and 18 patients with chronic venous insufficiency by means of a fast scanning reflection photometer and determined noninvasively the hemoglobin oxygen saturation (S(HB)) and the relative concentration of hemoglobin (C(HB)) in the skin of the forefoot and at the calf, 10 cm proximal of the inner malleolus during positional changes. In supine position no significant differences were found. During sitting and standing S(HB) dropped and was significantly lower in patients at both locations (calf, standing, patients 22.2 +/- 10.6% vs controls 48.2 +/- 13.5%, P < 0.001). C(HB) increased in patients during standing from 0.71 to 2.13 +/- 0.33 aU (in controls from 0.69 to 1.49 +/- 0.28 aU, P < 0.001). Activation of the muscle pump decreased C(HB) and increased S(HB) in patients and in controls. After the movements were stopped, S(HB) decreased again and fell to the initial low values eight times faster in patients (7.4 +/- 5.3 vs 57.5 +/- 19.6 sec, P < 0.001). C(HB) increased four times faster in patients (7.2 +/- 6.1 vs 29.9 +/- 13.6 sec). In sitting and standing positions hemoglobin oxygenation in the skin of the lower limb was markedly reduced in patients, but normal perfusion conditions were restored in supine position, indicating reversibility of the changes. Reflection oxymetry seems a valuable tool for the assessment of chronic venous insufficiency. The substantially reduced oxygenation of dermal hemoglobin in standing patients may contribute to the development of venous ulcers.

Adult↗

Bowel wall visualisation at CT colonography.

PURPOSE: To evaluate the quality of bowel wall visualisation at CT colonography and the impact of examination in the supine and prone positions. MATERIAL AND METHODS: After bowel preparation, 111 patients underwent CT colonography. Air distension, degree of fluid redistribution with change in body position (supine and prone), influence of residual stool on bowel wall assessability, and quality of overall colon visualisation were evaluated using scales. RESULTS: Thirty of 110 patients (27%) had complete overall visualisation of the colon wall and 52 (47%) had subtotal visualisation of a limited part of the colon. The entire colon was more often air-filled in the prone position (46%) than in the supine position (18%). Joint review of supine and prone data showed that for all colon segments, except the sigmoid (86%), > or =95% of the patients had complete air filling. All patients had residual fluid. In 75% to 99%, depending on segment, fluid did not interfere with the bowel wall visualisation in the combined evaluation of supine and prone data sets. Thirty-one patients had residual stool with potential negative influence on polyp detection. CONCLUSIONS: The colon wall was completely, or almost completely, visualised in 75% of the patients, and examination in the supine and prone positions was necessary for complete visualisation.

Adult↗

Influence of change in body position on choroidal blood flow in normal subjects.

AIM: To compare subfoveal choroidal blood flow (ChBF) in sitting and supine positions in normal volunteers. METHODS: ChBF was measured with laser Doppler flowmetry in 22 healthy volunteers of mean (SD) age 24 (5) years. Six independent measurements of ChBF were obtained in one randomly selected eye of each subject while seated. The subjects then assumed a supine position for 30 minutes and a new series of six measurements was obtained. The mean values of the two series were calculated. Systemic brachial artery blood pressure and intraocular pressure were measured in the sitting and supine positions. Ocular perfusion pressure (OPP) was calculated based on formulae derived from ophthalmodynamometric studies. The influence of changing OPP during change in body posture on the change in ChBF was assessed by linear regression analysis. RESULTS: ChBF decreased by 6.6% (p = 0.0017) in the supine position. The estimated ophthalmic blood pressure in the supine position was adjusted to obtain a result of no change in OPP for no change in ChBF, yielding a mean decrease in the estimate of OPP of 6.7% (p = 0.0002). The necessary adjustment for the estimate of OPP in the supine position suggested a marked buffering of the change in perfusion pressure by the carotid system. The relative decrease in OPP correlated significantly with the relative decrease in ChBF (R(2) = 0.20; p = 0.036) with a slope for the regression line of 1.04. CONCLUSIONS: The comparable degree of change in ChBF and OPP and the linear relationship between the two parameters suggest a passive response of the choroidal circulation to a change in posture. In contrast, the carotid system seems to control the gradient in perfusion pressure closely between the heart and its branches.

Adolescent↗

[Measurement of oral and facial blood flow with a laser Doppler flowmeter. 4. Alteration of oral blood flow by position change].

The laser doppler flowmeter was developed by Stern in 1975 and applied for practical use by Nilsson et al. in 1980. Since then, it has been used in various fields of medicine. The primary advantages of this device an that it is noninvasive and can monitor the blood flow continuously and rapidly. We used a Laser doppler flowmeter to continuously monitor the change in the oral peripheral blood flow due to changes in the body position of patients in a dental chair, since such changes are unavoidable during the course of dental treatment. A change from the sitting position to the supine position caused an increase in oral blood flow in 19 of 20 patients. In terms of the mean value per minute, oral blood flow was 23% greater in the supine position.

Blood Flow Velocity↗

Effects of body position, hyperinflation, and blood gas tensions on maximal respiratory pressures in patients with chronic obstructive pulmonary disease.

BACKGROUND: Inspiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD) can be affected by mechanical factors which influence the length of the diaphragm, and by non-mechanical factors. The aim of the present study was to evaluate firstly the effects of body position on respiratory pressures and, secondly, to determine the relative contribution of age, body mass index (BMI), lung volumes, and arterial blood gas tensions to respiratory muscle strength. METHODS: Thirty male patients with stable COPD (mean FEV1 40.4% predicted) participated in the study. Maximal inspiratory and expiratory mouth pressures (PImax, PEmax) and maximal inspiratory transdiaphragmatic pressures (PDI) in the sitting and supine position, lung function, and arterial blood gas tensions were measured. RESULTS: Mean (SD) PImax in the sitting position was higher than in the supine position (7.1(2.3)kPa v 6.4(2.2)kPa respectively). In contrast, PDI in the sitting position was lower than in the supine position (10.0(3.5)kPa v 10.8(3.7)kPa respectively). PEmax was higher in the sitting position (9.3(3.0)kPa) than in the supine position (8.7(2.8)kPa). Significant correlations were found between inspiratory muscle strength on the one hand, and lung function parameters, BMI, and arterial blood gas tensions on the other. CONCLUSIONS: Inspiratory muscle strength in patients with COPD is influenced by mechanical factors (body position, lung volumes) and non-mechanical factors (BMI, FEV1, and blood gases). PImax and PEmax are lower in the supine position while, in contrast to healthy subjects, PDI is higher in the supine position than in the sitting position.

Aged↗

[Clinical and experimental studies on the pathogenesis in pregnancy induced hypertension].

Placental ischemia is one of the etiological factors of pregnancy induced hypertension (PIH), however, the pathogenesis of placental and renal ischemia has not been clarified. The purposes of this investigation are (1) to clarify the fetomaternal hemodynamic changes in PIH and the influence of maternal postural change on fetomaternal hemodynamics, measured by thermodilution method, impedance cardiography and pulsed doppler method during pregnancy, (2) to provide to relationship between intrauterine resting tonus and maternal hemodynamics, that is, blood pressure, placental and renal blood flow measured by electromagnetic flowmeter and thermocouple method, and renal nerve activity, and (3) to study the influence of placental ischemia on vascular sensitivity to angiotensin II measured by Magnus method in animal experiment. (1) The increase in C.O and blood volume were recognized from the beginning of pregnancy to 24 GW, and subsequently, the decreasing tendency were found from about 32 GW to the onset of labor. However this decreasing tendency were subsided in the lateral position. These circulatory changes were observed in both normotensive and PIH cases, and especially, the decrease in C.O and blood volume in late pregnancy were more remarkable in PIH than that in normotensive pregnancy. From the results of Starling curve, left ventricular work was more hyperdynamic status in PIH than that in normotensive pregnancy, these results show that there are a compensatory mechanism against high vascular resistance in PIH. A/B (S/D) ratio in uterine artery, umbilical artery and fetal aorta were lowered in II-nd and III-rd trimester and more decreased in the lateral position from the supine position, on the other hand these ratio in PIH were elevated respectively. These results show that there are the aortocaval compression by the heavy tensive uterus and subsequent sluice flow mechanism in fetoplacental circulation in the supine position in late pregnancy. (2) These vascular compression were recognized very often in PIH accompanying with increasing in uterine resting tonus. It was recognized in pregnant rabbit that an increase in uterine resting tonus in the ovarian side caused an increasing blood pressure, a decrease in renal and placental blood flow and an increase in renal sympathetic nerve activity (RSNA). After resection of the suspensory ligament of ovarii, an increase in resting tonus in the ovarian side did not only cause an increase in RSNA, but also a decrease in renal blood flow.(ABSTRACT TRUNCATED AT 400 WORDS)

Angiotensin II↗

[Evaluation of reproducibility of plethysmographic indices according to body posture, choice of forearm and method of measurement].

The aim of the study was the analysis of the influence: a) body position (sitting vs. supine), b) choice of the arm (dominant vs. nondominant), c) variant of the method (classic vs. automatic) on plethysmographic indices describing forearm blood flow repeatability (arterial inflow--AI, fast blood flow--FBF, venous outflow VO, venous capacitance--VC). The study group included subjective healthy men, aged from 22 to 60 years. Individuals with body mass index (BMI) > 35 kg/m2 or treated pharmacologically weren't been included into examination. The indices of the forearm blood flow were calculated from the plethysmographic curve using the graphic technique: venous capacitance (VC), arterial inflow (AI), fast blood flow (FBF) and venous outflow (VO). We used relative repeatability coefficient (RRC) and coefficient of variation (CV) for assessing repeatability of obtained parameters. Repeatability of plethysmographic indices was better in supine position than in sitting one. RRC was respectively for supine vs. sitting position for VO: 0.41 vs. 0.68, for VC: 0.42 vs. 0.52 and for AI: 0.57 vs. 0.65. Plethysmographic indices VO, VC, AI were characterised by better repeatability when the exams were performed on the dominant arm. RRC was respectively for dominant vs. nondominant arm for VO: 0.68 vs. 0.71, for VC: 0.52 vs. 0.64 and for AI: 0.65 vs. 0.71. Coefficient of variation of arterial inflow assessed by conventional, automatic and by fast inflow was respectively 20%, 23% and 17%. The long-term repeatability of FBF estimated by RRC was 0.76 whereas CV yielded 17%. The same coefficient of variation was obtained when short-term repeatability was estimated-mean value CV was 17%, after rejection extremal values 11%. In conclusion the best repeatability was obtained when measurements were performed with automatic variant of method, in supine position, on dominant arm.

Adult↗